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CIE - International Student Departure Survey

1. Student Information

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* 1. Name:

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* 2. SEVIS Number (top right hand corner of I-20/DS-2019)

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* 3. Future Contact Information:

Address: *

Address 2:

City/Town: *

State:

ZIP/Postal Code: *

Country: *

Email Address: *

Phone Number: *

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* 4. Gender:

Male

Female

Other

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* 5. What is your academic standing?

Exchange student

Freshman

Sophomore

Junior

Senior

Other

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* 6. What is your home institution (if applicable)?

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* 7. What is your citizenship?

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* 8. What is your visa status?

F-1

J-1

F-1 on OPT

Other